- ageing population, ironically because of the success of healthcare
- (US specific) avoidance of preventative/precautionary treatment for fear of outsized bills
- (US specific) wildly inefficient and predatory 'insurance' system
- Higher rates of overweight and obesity than almost any other country. Obesity is a top correlate of most of the most expensive chronic conditions.
- Healthy food is less available and more expensive than unhealthy, ultra processed food engineered to be hyper palatable and not very filling. Govt policy that reinforces and subsidizes this.
- Infrastructure design that discourages walking. Culture that encourages sedentary activities and lifestyle in general.
- Being overweight and out of shape has been culturally normalized. Propaganda telling us that weight is genetic, out of our control, and we can be "healthy at any size" anyway.
- Work culture that leads to chronic stress and time deprivation worsening all the other problems and leaving people unable to expend the time and energy to avoid chronic problems proactively by losing weight and being active.
Healthy food is not more expensive than ultra processed food. Easy healthy food is. You can go get quite a bit of basic meat and veggies for very little money compared to some Hot Pockets or McDonalds or whatever. I can make a stew for $15 that’s at least two meals for my family. Chuck roast, carrots, potatoes, onion, etc. Chicken is even cheaper.
Availability is only poor in areas where people won’t willingly buy raw ingredients. Food deserts are (largely) lazy oases.
Pick two. So you can have fast, cheap, but low quality food ('fast food'), or slow, cheap, good quality food (cooking at home), or fast, expensive, high quality food (decent restaurant).
By time I would also include mental overhead required, i.e. thinking about cooking. Unfortunately poor people often have neither the money or the time to choose quality.
The daft thing is that cooking individually, or indeed to order in a restaurant, is very inefficient. In fact it is possible to win on all 3, but this requires a communal style cafeteria as would be found in offices, schools, the military etc.
Wouldn't it be great if such cafeterias were available to the general public, with a limited but rotating good quality menu, using actual plates instead of single use plastic, bench seating such that singles would feel comfortable dining there, tap water on tap, self serve with trays.
You can find something like this in shopping malls, but often a wide menu instead of a rotating menu, so failing to scale and thus falling behind with quality
Check out https://turquoise.health/patients a startup scraping and standardizing the data.
How do you create a modicum of cost control and push back on providers introducing arbitrary markups?
The obvious answer here is that health insurance should not be privatized. Health insurance should be negotiating to keep costs low so that they can cover more, not letting costs skyrocket to make more profit.